Raksha Lakshya Social Foundation's DoD Program
Designing our Destiny (DoD). It will be maintained as Highly Confidential and will be accessible only to your immediate Social Family and our Authorized Social Coaches.
Email *
Full Name *
Mobile Number *
WhatsApp Number (Only if its a different number)
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Address *
City *
State *
Country *
Marital Status *
Intro to our Social Family about your Biological Family (On Parents, Siblings, Spouse and Children), along with their Age, Gender and Currently Alive Status : *
Religion *
Blood Group *
Emergency Contact (Name, Relationship, Location & Mobile Number) *
Native Language *
Other Languages Known (On these 4 aspects - To Understand, To Speak, To Read & To Write) *
Education *
Profession *
Organization(s) - Associated with & Associated as *
Annual Income (in INR), as there are different levels of challenges for different income groups *
What is your one specific most important goal to be achieved in next 90 days? *
According to you, what is keeping you stuck in achieving this goal? You need support in gaining : *
Required
How did you know about this program? *
Top 2 Expectations from this program *
(Optional) Are you willing to connect with other members of our Larger Community of Verified Users, outside your immediate Social Family?
Clear selection
(Optional) If yes to connect with larger community, Preferred Age Group
(Optional) If yes to connect with larger community, Preferred Gender?
A copy of your responses will be emailed to the address you provided.
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